Diabulimia: A Risky Trend Among Adults with Type 1 Diabetes Mellitus.

OBJECTIVE: Poor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia. METHODS: A 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia. RESULTS: Of the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018). CONCLUSION: Approximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.

Patient perspectives of barriers to naloxone obtainment and use in a primary care, underserved setting: A qualitative study.

Background: Gaps in naloxone obtainment and use are not well studied, particularly among minoritized groups. Objective: To describe patient perspectives that serve as barriers to naloxone obtainment and the number of patients who obtained naloxone in a primarily African American population in a primary care, underserved setting. Methods: This qualitative study conducted semi-structured interviews and included 36 adults who were prescribed naloxone at a federally qualified health center using convenience sampling. Participants answered survey questions describing naloxone acceptability, perceived risk for overdose, and barriers to naloxone use. Results: Sixty-nine percent of the patients were Black or African American. The majority of patients attempted to fill their naloxone at a local pharmacy (69%) and reported no difficulties (88%). Five major themes revealed: overall positive views of naloxone because it saves lives; existing knowledge gaps related to indications for naloxone prescription; stigma surrounding receiving a naloxone prescription; inadequacies of the patient education provided; and the role providers play in naloxone receptivity Conclusions: Among a majority African American population, many perceived naloxone to be lifesaving. However, stigmatizing perceptions and inability to recall patient education contribute to a perception of low overdose risk. Further research describing the impact of the opioid epidemic on underrepresented groups is necessary.

The CASTRO study: Unsafe sexual behaviors and illicit drug use among gay and bisexual men who use anabolic steroids.

BACKGROUND AND OBJECTIVES: The majority of anabolic androgenic steroid (AAS) studies have focused on the general male population. Approximately 15% of gay or bisexual men are seropositive for HIV and many AASs are administered via injection. Thus, AAS use among gay and bisexual men likely poses a greater risk of spreading infectious disease. Gay and bisexual men who use AAS were compared with non-users regarding self-reported seropositivity for HIV and hepatitis B and C, sexual behaviors and injection practices, illicit drug and alcohol use, and psychiatric disorders. METHODS: The CASTRO (Castro Anabolic Steroid Research Observation) study was a 108-item cross-sectional survey of 153 gay and bisexual men who exercise. Data collection occurred outside four gyms in the San Francisco Castro District. RESULTS: The lifetime prevalence of AAS use among gay and bisexual men in the study was 21.6%. AAS users and non-users did not differ in self-reported seropositivity for HIV or hepatitis B and C, but AAS users reported higher rates of male-male condomless anal sex in the past year (84.8 vs 60.8%, p < .01) than non-users. More AAS users used ecstasy and methamphetamines (39.4 vs 16.7%, p < .01 and 18.2 vs 5.0%, p = .01, respectively) than non-users. DISCUSSION AND CONCLUSIONS: Gay and bisexual men who used AAS were more likely to engage in unsafe sexual behaviors and use illicit drugs relative to non-users. Multiple factors place AAS users at higher risks for spreading infectious diseases. SCIENTIFIC SIGNIFICANT: Our study suggests increased infectious disease risk among gay and bisexual men who use AAS. (Am J Addict 2019;XX:1-10).

Polypharmacy, Infectious Diseases, Sexual Behavior, and Psychophysical Health Among Anabolic Steroid-Using Homosexual and Heterosexual Gym Patrons in San Francisco's Castro District.

BACKGROUND: Limited studies based in England and Australia reported misuse of anabolic-androgenic steroids (AAS) among homosexual men to enhance body image. Anecdotally, AAS are also being misused by homosexual men in the United States. Since many AAS and certain performance enhancing drugs (PEDs) are administered via injection, this poses a potential vector for the spread of infectious disease in an already at-risk population. OBJECTIVES: This study compared and contrasted homosexual and heterosexual male gym clients regarding use of AAS and PEDs, use of alcohol and illicit drugs, seroprevalence of infectious disease, engagement in risky injection practices and sexual behaviors, and presence of psychiatric conditions. METHODS: Recruitment and data collection occurred outside four exercise gyms in the San Francisco Castro District area between October 25, 2014 and March 10, 2015. Two hundred and twenty homosexual men and 73 heterosexual men completed the 114-item cross-sectional survey. RESULTS: Ten percent of homosexual men reported lifetime AAS use. Homosexual men had almost four times more sexual partners and were over 14 times more likely to knowingly have unprotected intercourse with a known HIV positive person than heterosexual men. In addition, a quarter of homosexual men who injected drugs admitted to sharing used syringes or needles with another person. Conclusions/Importance: The current study is the first to confirm AAS use among homosexual men in the United States. Homosexual men partook in high-risk sexual behaviors and injection practices which may place them at greater risks for contracting and spreading HIV and other infectious diseases.

Valproic acid-induced hyperammonemia and minimal hepatic encephalopathy prevalence among psychiatric inpatients.

BACKGROUND: Our purpose was to evaluate the relationship between valproic acid (VPA)-induced hyperammonemia (HA) and the prevalence of minimal hepatic encephalopathy (MHE) cognitive impairment among psychiatric inpatients. METHODS: Fifty-two psychiatric inpatients prescribed VPA were tested for MHE impairment after achieving steady-state VPA and ammonia concentrations during hospitalization between December 2013 and June 2014. The relationship between steady-state VPA and ammonia concentration was tested by correlation coefficient. Patients completed a battery of 5 psychometric tests that determined a Psychometric Hepatic Encephalopathy Score (PHES), which was used to test the association between a PHES <-4 cutoff for MHE impairment and HA exposure (ammonia >50 µmol/L) by chi-square testing. RESULTS: Steady-state VPA plasma concentration was not correlated significantly with ammonia concentration (r = 0.24, P = .093). The patients with HA did not have a higher proportion of MHE cognitive impairment than patients with normal ammonia exposure (43.8% vs 66.7% respectively, P = .806). CONCLUSIONS: Steady-state VPA concentration was not correlated with ammonia concentration and VPA-induced HA was not associated with a greater prevalence of MHE impairment. This suggests that the MHE impairment PHES cutoff might not detect VHE in psychiatric inpatients without cirrhosis, especially because inpatients could experience cognitive impairment related to acute mental illness.

A Student's Nontraditional Path to Pharmacy School.

Although professional pharmacy programs tend to require and focus heavily on applicants' grade point averages and pre-admission test scores, there is noted value in the matriculation of students exhibiting strong leadership and soft skills. Such attributes are advantageous to a pharmacist, particularly when considering the current need to develop trailblazers prepared to adapt to the ever-changing demands of our healthcare system. Pharmacy school applications and enrollments have been declining across the nation for the past decade. Pharmacy job prospects, particularly in community pharmacies, are projected to decline over the next decade, but inpatient and clinical roles are projected to increase in demand. To accommodate this role shift, schools may consider engaging with and recruiting students with unique skill sets from less traditional backgrounds. This commentary explores one student's pharmacy school experience via the lens of a nontraditional background and postulates that pharmacy schools may benefit from altering their admissions approach.

Multiple comparisons: To compare or not to compare, that is the question.

Researchers attempt to minimize Type-I errors (concluding there is a relationship between variables, when there in fact, isn't one) in their experiments by exerting control over the p-value thresholds or alpha level. If a statistical test is conducted only once in a study, it is indeed possible for the researcher to maintain control, so that the likelihood of a Type-I error is equal to or less than the significance (p-value) level. When making multiple comparisons in a study, however, the likelihood of making a Type-I error can dramatically increase. When conducting multiple comparisons, researchers frequently attempt to control for the increased risk of Type-I errors by making adjustments to their alpha level or significance threshold level. The Bonferroni adjustment is the most common of these types of adjustment. However, these, often rigid adjustments, are not without risk and are often applied arbitrarily. The objective of this review is to provide a balanced commentary on the advantages and disadvantages of making adjustments when undertaking multiple comparisons. A summary discussion of familiar- and experiment-wise error is also presented. Lastly, advice on when researchers should consider making adjustments in p-value thresholds and when they should be avoided, is provided.

A narrative review of using prescription drug databases for comorbidity adjustment: A less effective remedy or a prescription for improved model fit?

BACKGROUND: The use of claims data for identifying comorbid conditions in patients for research purposes has been widely explored. Traditional measures of comorbid adjustment included diagnostic data (e.g., ICD-9-CM or ICD-10-CM codes), with the Charlson and Elixhauser methodology being the two most common approaches. Prescription data has also been explored for use in comorbidity adjustment, however early methodologies were disappointing when compared to diagnostic measures. OBJECTIVE: The objective of this methodological review is to compare results from newer studies using prescription-based data with more traditional diagnostic measures. METHODS: A review of studies found on PubMed, Medline, Embase or CINAHL published between January 1990 and December 2020 using prescription data for comorbidity adjustment. A total of 50 studies using prescription drug measures for comorbidity adjustment were found. CONCLUSIONS: Newer prescription-based measures show promise fitting models, as measured by predictive ability, for research, especially when the primary outcomes are utilization or drug expenditure rather than diagnostic measures. More traditional diagnostic-based measures still appear most appropriate if the primary outcome is mortality or inpatient readmissions.

Pharmacy-faculty work-life balance and career satisfaction: Comparison of national survey results from 2012 and 2018.

Background: Changes in demographics and composition of pharmacy faculty, along with faculty perceived stress, work-life balance and career satisfaction have yet to be fully documented. Objective: To compare recent results from a national survey of work-life balance and career satisfaction of United States (U.S.) pharmacy faculty with results obtained from a similar survey from 2012. Methods: A 46-item anonymous survey administered via Qualtrics (Provo, UT) was sent to members of the American Association of Colleges of Pharmacy (AACP) in 2018. Information regarding demographics, stress, work-life balance, career satisfaction and intent to leave academia was collected. Although not part of the previous survey, participant information related to bullying and abuse in the pharmacy academic work was also gathered. While actual p-values are reported for all comparisons, a more conservative p-value of 0.01 was chosen a priori to indicate significance as multiple comparisons were made. Results: A total of 1090 pharmacy faculty completed the survey, comparable to the number obtained in 2012 (n = 811). Overall response rates were similar for both years. The majority of pharmacy faculty in 2018 were female, white, married or with partner, worked in a pharmacy practice department and for a public institution. Notable differences between surveys included an increase in females, more associate professors and an increase in non-white faculty in 2018, relative to 2012. Stress, as measured by mean Perceived Stress Scale (PSS) scores was also significantly higher in 2018 (16.0 ± 6.6 vs. 13.5 ± 6.7, p < 0.01) relative to 2012. Faculty from 2018 were significantly less likely to report an intention to remain in academia (61.8% vs 86.3%, p < 0.01), relative to 2012. A sizable number of pharmacy faculty surveyed in 2018 also reported observing or experiencing hostility in the workplace, which included either bullying or verbal or physical abuse. Conclusions: The makeup of pharmacy educators has evolved quickly over the last several years to comprise more female and associate professors who work within a pharmacy practice department. Also noteworthy is the significant increase in self-reported stress over the six-year timeframe. The direct implications of these findings are unknown but suggest that pharmacy academia is maturing in rank and changing to reflect the current pharmacy workforce (i.e., more females and additional clinical practice roles). Increases in responsibility likely accompany these maturing roles and may, along with other factors, contribute to the observed changes in the reported stress levels among faculty. Further research is called for regarding the reported hostility in pharmacy academic workplace and dovetails with concurrent work being done on citizenship and organizational citizenship behavior among pharmacy faculty. Findings of the study may aid pharmacy school administrators and stakeholders with plans to recruit, develop and retain faculty.

Community pharmacists' lack of knowledge and confidence in non-prescription cannabidiol products.

BACKGROUND: Non-prescription cannabidiol (CBD) products have recently been available in community pharmacies. However, there is only limited data to support its use, placing community pharmacists in a challenging position to provide evidence-based information to patients. OBJECTIVE: The objective of this study was to assess knowledge, experience, and confidence of non-prescription CBD products among community pharmacists. METHODS: A 38-question pen-and-paper survey pertaining to knowledge, experience, and confidence of non-prescription CBD products was administered to community pharmacists in the California Bay Area. Inclusion criteria consisted of registered pharmacists at community pharmacies during regular business hours. Participants were excluded if they were under 18 years old or unwilling to participate. RESULTS: Of 128 pharmacists, 103 took part and completed the survey (response rate 80.4%). The majority (78.5%) were unable to answer at least 80% of the non-prescription CBD knowledge-based questions. Over 50% have received patient questions and 20.4% recommended non-prescription CBD products in the last 12 months. More than half were "not confident" answering questions about non-prescription CBD products, and 14.5% received formal training on the topic. CONCLUSION: Despite patients commonly asking about non-prescription CBD products, the majority of pharmacists lack clinical knowledge and confidence on the topic. There is a need to provide formal training and educational resources on non-prescription CBD products.

Assessment of Cultural Competence in Pharmacy Students Prior to Advanced Pharmacy Practice Experiences.

Objective. To assess various aspects of cultural competence in second year Doctor of Pharmacy students' and investigate the relationship between cultural competence and students' demographics, work experience, and prior education.Methods. A 63-item survey modified from the Clinical Cultural Competency Questionnaire (CCCQ) and comprising four domains (knowledge, skills, encounters or situations, and attitudes towards cultural competency) was administered to second year pharmacy students before they started their advanced pharmacy practice experiences (APPEs). Additional questions regarding their ability to identify and recognize elements of cultural competence were asked. The effects of demographics, work experience, and education on cultural competence also were assessed.Results. Ninety-seven students (86.6%) participated in the study. The majority of participants were Asian, female, and in their late 20s. Most students agreed or strongly agreed that they could identify and recognize elements of cultural competence. However, participants indicated they were only a little or somewhat comfortable when asked questions about knowledge, skills, and comfort. Students indicated they had "quite a bit" of competence regarding attitudes towards other cultures. Previous cultural diversity training in undergraduate studies and pharmacy school were associated with higher scores on the modified CCCQ.Conclusion. The findings emphasize the importance of schools providing training in the didactic and experiential portion of the pharmacy curriculum to increase pharmacy students' knowledge, skills, comfort, and attitudes towards other cultures.

Use of actigraphy and sleep diaries to assess sleep and academic performance in pharmacy students.

INTRODUCTION: Sleep parameters have been shown to correlate with academic performance. Current studies assessing sleep in doctor of pharmacy (PharmD) students rely on self-reported sleep parameters and academic performance. The objectives of this study were to describe and compare sleep parameters in pharmacy students using actigraphy and sleep diaries and to assess the correlation of sleep parameters with academic performance. METHODS: This prospective cohort study with convenience sampling assessed sleep parameters in pharmacy students. Thirty-five students completing the second year of a PharmD program participated in the study. Participants wore actigraph watches and maintained sleep diaries for seven consecutive days during the spring and fall semesters, while classes were in session, except for one week prior to exams and the week of exams. Academic performance was tracked during fall and spring semesters. RESULTS: Actigraphy and sleep diaries showed significant differences in sleep latency (SL), actual sleep time (AST), wake bouts, and sleep efficiency (SE). Actigraphy results indicated that the participants fell asleep faster (SL), slept a shorter duration (AST), had more wake bouts, and lower SE than results reported in the sleep diaries. SE and SL from the sleep diaries positively correlated with the fall semester pharmaceutical sciences course and overall spring semester academic performance. Actigraphy recorded AST correlated with performance in both semesters' clinical sciences courses. CONCLUSIONS: The results of actigraphy differed from the sleep diaries. More studies are needed to assess differences in detection of sleep parameters using sleep diaries and actigraphs.

Comparing perceptions of professionalism by pharmacy students, faculty, and staff during didactic education.

INTRODUCTION: The objectives were to describe pharmacy students' perceptions of professionalism and to compare students and faculty/staff perceptions of professionalism during the didactic years at Touro University California College of Pharmacy in California (TUC COP). METHODS: A two-part online survey was administered to the TUC COP faculty/staff and first-year (P1) and second-professional year (P2) students in May 2016. The first part of the survey collected demographic information, assessment of faculty/staff and students' overall opinions on behavior and conduct displayed by P1 and P2 students, students' responses about the average of missed lectures per month, and the average number of days of late arrival to lecture per week. The second part assessed professionalism perceptions responses to 20 scenarios using a 4-point Likert rating. RESULTS: The study included 37 (88.4%) faculty/staff and 181 (96.4%) P1 and P2 students, for a 98% response rate. Of the faculty/staff, 59.5% perceived the students' overall behaviors and conduct as acceptable whereas 35.3% of students perceived the overall behavior of P1 and P2 students as acceptable, with the majority of students self-reporting missing on average fewer than five lectures per month (65.2%) and arriving late to lecture fewer than one day each week (71.8%). There were statistically significant differences between faculty/staff and students' responses in 9 of the 20 scenarios. CONCLUSIONS: Differences in responses between faculty/staff and students regarding what is considered professional suggest that there is a gap in professionalism perceptions that should be addressed during didactic years.

Interprofessional Education on Medication Adherence: Peer-to-Peer Teaching of Osteopathic Medical Students.

CONTEXT: Medication nonadherence is an important barrier to achieving optimal clinical outcomes. Currently, there are limited data on methods used to train medical students about medication adherence. OBJECTIVE: To evaluate the knowledge, confidence, and attitudes of first-year osteopathic medical students before and after a 30-minute peer-to-peer medication adherence education program led by a third-year pharmacy student. METHODS: All first-year medical students from Touro University California College of Osteopathic Medicine were invited to participate in 1 of 3 medication adherence educational sessions held in May 2019. A third-year pharmacy student who received training from Touro University California College of Pharmacy faculty served as the peer educator. Each session took approximately 1 hour to complete. The session included a preprogram survey, a 30-minute program, and a postprogram survey. Survey items included demographics; medication adherence knowledge, confidence, and attitudes; and attitudes toward the peer-to-peer educational format. Statistical comparisons of preprogram and postprogram knowledge, confidence, and attitudes were made using a paired t test, the McNemar test, and the Wilcoxon signed-rank test. P<.05 was considered statistically significant. A sample size calculation was performed using mean knowledge scores to determine whether the study achieved 80% power. RESULTS: Twenty-three students participated in the study. Medication adherence knowledge scores improved after the program (17.4 [77.4%] vs 9.98 [92.2%]; P<.001). Confidence scores also improved for all 7 survey items (P<.001). Medical students had more positive attitudes toward medication adherence after the program, with 8 of 10 survey items in this domain showing improvement. Most students had a positive attitude toward the peer-to-peer educational format. All participants reported that they would implement the medication adherence skills learned at the program with future patients. CONCLUSION: A 30-minute peer-to-peer program led by a pharmacy student improved first-year medical students' knowledge, confidence, and attitudes with regard to medication adherence and provided an effective format to enhance interprofessional learning and collaboration.

Glyburide Use in Older Adults: Pharmacy Claims Data Analysis of a Regional Healthcare Organization.

BACKGROUND/OBJECTIVES: Glyburide was added to the 2012 American Geriatrics Society (AGS) Beers Criteria® due to the risk of hypoglycemic events in older adults. The objective of this study was to evaluate trends of glyburide use in persons aged 65 and older with diabetes mellitus, type II, before, during, and after the 2012 AGS Beers Criteria® Update. DESIGN: Multicenter retrospective cohort study comparing pharmacy claims data from four Sharp Rees-Stealy clinic regions over 5 years (2010-2015). SETTING: Pharmacy claims database. PARTICIPANTS: A total of 3,005 patients with diabetes mellitus, type II, aged 65 and older. MEASUREMENTS: Prescription fill history of the sulfonylureas glyburide, glipizide, and glimepiride were collected along with comorbidity (Elixhauser) and demographic information. Odds of glyburide prescribing were stratified by year, clinic region, and by prescriber type. RESULTS: Glyburide use decreased across each study year (35.8%, 27.7%, and 4.2% in 2011, 2013, and 2015, respectively; P < .01). Adjusted odds of glyburide use indicated that regions A and D were 24% (P = .045) and 11% (P < .01) less likely to prescribe glyburide in 2011, regions A and D were 37% (P < .01) and 8% (P = .03) less likely to prescribe glyburide in 2013, respective to the overall average, whereas region B was 41% (P = .04) more likely. No significant regional site variations remained in 2015. Internists were 47% more likely to prescribe glyburide than family medicine providers in 2013; P < .01), but not in any other study years. CONCLUSION: Rates of glyburide use decreased after release of the 2012 AGS Beers Criteria® demonstrating successful adoption of evidence-based medicine at a large multiregional site. However, regional differences may affect timing of implementation. Education, system-level initiatives, and strong professional support may help enhance more uniform adoption. J Am Geriatr Soc 68:2354-2358, 2020.

Relationship of Burnout and Engagement to Pharmacy Students' Perception of Their Academic Ability.

Objective. To assess burnout and engagement in first- and second-year Doctor of Pharmacy (PharmD) students and to investigate their relationships to students' perception of their academic ability. Methods. An online survey that included three validated scales was administered in May 2017 to first- and second-year pharmacy students enrolled in didactic coursework at Touro University California College of Pharmacy. The Maslach Burnout Inventory was used to assess burnout and the Utrecht Work Engagement Scale was used to measure student engagement. To characterize academic ability, Academic Self-Perception, a subscale of the School Attitude Assessment Survey-Revised, was used. Regression analysis was performed using statistical software. Results. One hundred sixty-two students (81.4% response rate) completed the survey. Emotional exhaustion and professional inefficacy were negatively correlated with students' academic self-perception. Dedication was positively correlated with academic self-perception. Conclusion. In pharmacy students completing the didactic portion of the PharmD curriculum, various engagement and burnout parameters correlated with academic self-perception.

Anabolic steroid users' misuse of non-traditional prescription drugs.

BACKGROUND: Few anabolic-androgenic steroid (AAS) users disclose their performance enhancing drug (PED) use with their healthcare providers. AAS users practice polypharmacy with prescription medications to counter adverse effects of AAS, to further their muscular gains, or to lose weight. OBJECTIVES: To compare and contrast AAS using and non-AAS using gym clients regarding PED use, in particular prescription drugs. METHODS: The CASTRO (Castro Anabolic Steroid Research Observation) study was a 108-item cross-sectional survey that took place at four gyms in San Francisco, California between August 2015 and January 2016. 40 AAS users and 179 non-AAS users completed the survey. RESULTS: The prevalence of AAS use in the study cohort was 18.3%. AAS users reported using a greater number of total PEDs (8.7 ±â€¯4.2 vs. 3.7 ±â€¯2.1, p < 0.001) than non-AAS users. AAS users were more likely to misuse the following prescription drugs: antiestrogens (tamoxifen, anastrazole), fertility agents (clomiphene, human chorionic gonadotropin), erectile dysfunction drugs (tadalafil, sildenafil), anabolic drugs (clenbuterol, recombinant human growth hormone), and weight loss drugs (liothyronine). CONCLUSIONS: AAS users practice polypharmacy and misuse multiple prescription drugs. These findings allow researchers and clinicians to be more knowledgeable and to anticipate potential misuse of prescription medications that traditionally are not thought to be abused.

Trends in and Barriers to Enrollment of Underrepresented Minority Students in a Pharmacy School.

Objective. To compare the mean national enrollment rates of underrepresented minority (URM) students in a pharmacy school with mean rates in California pharmacy schools, and identify barriers faced by URM students during the application process. Methods. The American Association of Colleges of Pharmacy (AACP) enrollment data from 2005 to 2014 were used to compare the demographics of California pharmacy schools with the average enrollment of URM students in pharmacy schools nationally. A survey was administered to students in the 2017 and 2018 classes at Touro University California College of Pharmacy to identify common barriers that students faced in pursuing pharmacy education. Results. The average enrollment of URM in pharmacy programs nationally was 12.3% in 2005, compared to 12.4% in 2014. The average enrollment of URM in California pharmacy schools was 9.4% in 2005 compared to 8.5% in 2014. The top barriers to pursuing pharmacy education that students reported included the cost of tuition (43.4%), prerequisite requirements (36.9%), and obtaining letters of recommendation (32.3%). Conclusion. The average enrollment of URM students in pharmacy schools nationally has remained higher than that in California pharmacy schools across the years studied. California pharmacy programs should develop strategies to alleviate the barriers identified and further diversify pharmacy education.

What is the impact of the 2017 cochrane systematic review and meta-analysis that evaluated the use of PCSK9 inhibitors for lowering cardiovascular disease and mortality?

INTRODUCTION: In 2017, Schmidt et al. conducted a Cochrane systematic review and meta-analysis to evaluate the effect of using proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to reduce low-density-lipoprotein- cholesterol (LDL-C) and cardiovascular disease (CVD). The Cochrane review was a systematic review and meta-analysis of 20 randomized, double-blinded trials that compared the use of PCSK9 inhibitors with statins/ezetimibe, ezetimibe, or placebo for a treatment duration of at least 24 weeks. The use of PCSK9 inhibitors lowered the risk for CVD (OR 0.86 (0.80 to 0.92)) but not mortality (OR 1.02 (0.91 to 1.14)) when compared to placebo. Areas covered: The following article evaluates the recently published Cochrane review and clarifies the efficacy of PCSK9 inhibitors for improving cardiovascular morbidity and mortality. Expert opinion: The Cochrane review discussed suggests that PCSK9 inhibitors are effective in lowering LDL-C and the risk of CVD but not the risk of mortality. The higher price of PCSK9 inhibitors is a further deterrent for using them as a substitute for statins - cholesterol lowering medications with history showing they lower mortality. Statins should remain the gold-standard cholesterol-lowering drug class until PCSK9 inhibitors become more affordable and demonstrate consistent efficacy for reducing CVD and mortality.

Gender-Based Differences Among Pharmacy Students Involved in Academically Dishonest Behavior.

Objective. To determine whether differences based on gender exist among pharmacy students involved in cases of admitted cheating or other academic dishonesty and to assess perceptions of academic dishonesty. Methods. Two cohorts of second-year male and female pharmacy students from four Northern California pharmacy programs were invited to complete a 45-item cross-sectional survey. Descriptive statistics and Pearson's chi-squared test were used for statistical analysis. Results. There were 330 surveys completed with a 59% response rate. No significant gender-based differences were found regarding admitted cheating in pharmacy school and in regards to participating in various forms of academically dishonest behavior. Female students were more likely than male students to report witnessing a classmate copying another student's assignment. Male students were less likely than female students to perceive a student who distributed a stolen exam as a cheater. Conclusion. No gender-based differences were noted in cases of admitted cheating or with regards to taking part in various forms of academically dishonest behavior. However, female students report witnessing cheating more than male students, and male students may have a more lenient perception toward academically dishonest behavior than female students. The information gathered from this study may provide further insight to pharmacy programs and educators regarding academic dishonesty at their institution.